Insurance companies generally process a claim by performing a number of related tasks that include numerical cost estimates, information management, and communications between, for example, insurance company offices and employees in the field. The sum of tasks performed in claims processing make up the claim settlement process. The claim settlement process includes making estimates of losses and appraising values of damaged property. The estimates and appraisals are usually conducted by an appraiser or a repair shop. Reinspection is the process of auditing and evaluating the accuracy, quality and timeliness of claim estimates and appraisals.
Many insurance companies have weak or non-existent control over their appraisal process because reinspection is an exceptionally manual process. For appraisals and estimates, insurance companies evaluate the quality of the appraisal or estimate only after the appraisal or estimate has been completed. Desk reviewers manually review appraisals or estimates to ensure that the correct rates have been used. To perform this review, the desk reviewer will manually compare the appraisal or estimate with profile information defined by the insurance company. This profile information includes company specified rules and threshold values for estimate amounts, property damage limitations, loss limitations or discounts. The desk reviewer then completes paper forms to document the profile exceptions—where the appraisal or estimate deviates beyond the threshold values given in the profile. After completing the paper form, the desk reviewer may call the repair shop to negotiate a change in the estimate. A problem with reinspections is that they often are unable to affect the severity of the claim settlement (i.e., the money paid out) due to the time necessary to complete the reinspection process.
Management of the performance of the appraiser or repair shop is performed by manually logging any items found during the reviews onto paper forms for each appraisal reviewed. The results of the individual reinspections are then manually aggregated into a report that can be used to audit the performance of the appraiser or repair shop. Management of the reinspectors performance is typically cursory and insurance companies often find it difficult to evaluate the productivity of a reinspector because they have no ability to monitor their activity.
Accordingly, there is a need for a comprehensive system and method of managing the reinspection process of insurance claims to assist insurance companies in managing estimate and appraisal quality and timeliness. Further, it would be advantageous to provide an automated tool to address the entire reinspection process in order to reduce costs and leverage existing resources.